Existential homecoming when facing death: A meta-ethnography of the end-of-life experiences of patients with a life-threatening illness.

Background

Serious illness influences existential well-being. Dwelling is an existential dimension of well-being when coming to terms with one's situation, yet there is limited knowledge about how this may be achieved and fostered in clinical practice.

Aim

To interpret and synthesise qualitative research findings about patients' experiences facing death at the end of life.

Design

A meta-ethnography based on Noblit and Hare's seven-phase process was conducted. DATA SOURCES CINAHL, Ovid Medline, APA PsycInfo, and Embase, were searched. Qualitative interview studies published between 2014 and 2025 on adult patients' experiences of facing death, with a life expectancy under 1 year, were included. Quality was assessed and considered satisfactory using the Critical Appraisal Skills Programme checklist.

Results

A total of 317 patients were included. We developed an overarching metaphor, Striving for existential homecoming, as an interpretative understanding and synthesis of patients' experiences when facing death. To find acceptance of their situation as a sense of peace amid suffering, patients navigated extreme endpoints; an ambiguity between life and death, wishing for normality while accepting and preparing for finality, and an intertwined loneliness and togetherness. This encompassed emotional tension between accepting and defending themselves against the nearness of death. Facing fear and uncertainty, patients sought meaning and hope, striving to belong while also feeling obliged to cope on their own.

Conclusions

Supporting meaning, connection, and belonging can foster a sense of "homecoming" for dying patients. Understanding existential homecoming may strengthen end-of-life care and should be emphasised in education and clinical practice.